When light enters your eye, it’s focused onto your retina at the back of your eye. Your retina sends nerve signals to your brain that are interpreted as visual images. The macula is a tiny area (about the size of a pinhead) in the centre of your retina. When you look directly at something, light is focused on the macula, allowing you to see clearly and in fine detail and colour.
With AMD, your macula cells become damaged and stop working properly. This leads to a gradual loss of your central vision. If you have AMD, your peripheral (side) vision isn’t usually affected, so it’s unusual to lose your sight completely.
AMD doesn’t always cause symptoms at first. So it’s important to have your eyes examined by your optometrist at least once every two years, even if your vision seems fine. Diagnosing AMD early on can help you get the right treatment.
AMD isn’t painful and you may not notice any symptoms at first. The symptoms vary from person to person.
Common symptoms include the following.
- Distorted vision – straight lines become wavy or look like they have a little bump in them.
- Blurring in the centre of your vision – seeing shapes or colours that aren't there.
- Night glare – being sensitive to bright lights, at night.
- Seeing a dark patch that rapidly fades when you wake up. You may think there’s a shadowy figure in front of you, which can be quite frightening.
- Difficulty reading and recognising people’s faces.
- Difficulty driving.
If you have dry AMD, your symptoms may develop slowly over several years. Dry AMD usually affects both of your eyes, but it may affect one eye before the other. Many people first notice a change in their ability to see details, for example when reading or recognising faces.
If you have wet AMD, you usually notice rapid vision loss over a few days or weeks. The first symptom is usually a blind spot in your central vision. You may then notice that straight lines appear crooked or wavy. Wet AMD usually affects one eye at a time.
If you notice any of these symptoms, see an optometrist straight away for an eye examination. An optometrist is a registered health professional who examines eyes, tests sight and dispenses glasses and contact lenses.
If you can't see an optometrist within a week, contact your GP as they may be able to refer you to an opthalmologist. An ophthalmologist is a doctor who specialises in identifying and treating eye conditions.
It’s important that you see an optometrist or ophthalmologist within one week of noticing your symptoms. If this isn't possible, or your symptoms are getting worse while you wait for your appointment, go to your local Accident & Emergency department. If you are diagnosed with AMD, early treatment can stop you losing your sight.
There are two main types of AMD: dry AMD and wet AMD.
- Dry AMD is the most common type. It affects around nine in every 10 people with AMD. The macular cells become damaged, leading to a build up of small yellow protein deposits called drusen. Your eyesight gradually gets worse. This type of AMD rarely causes blindness.
- Wet AMD affects around one in every 10 people with AMD. In wet AMD, the macula becomes damaged and new blood vessels start to grow behind your retina. These blood vessels can leak and cause scarring. If you have wet AMD, you may lose some or all of your central vision very quickly.
Your optometrist will check your vision and examine your eyes. To get a good view of your retina, your optometrist may use eye drops. These can blur your vision so you won’t be able to drive for a few hours after the eye examination. Your optometrist may notice pale yellow spots (drusen) on your retina. As people get older, they often have small drusen on their retina. But drusen often builds up when people have AMD.
Your optometrist may use an Amsler grid to check your central vision. This is a printed grid with a dot in the middle of it. You hold the grid at a comfortable reading distance and look at the dot with one eye at a time. Your optometrist will ask if you can see all four corners of the grid and whether any of the lines are missing or distorted.
If your optometrist thinks you may have AMD, they may refer you to an ophthalmologist.
Your ophthalmologist may suggest you have the following tests:
- Slit lamp microscope. Your ophthalmologist uses a special microscope to look for changes in your retina and macula, including a build up of drusen.
- Fluorescein angiography. A dye called fluorescein is injected into a vein in your arm. This travels through your bloodstream to your eyes making the blood vessels inside your eye visible on a photograph. These pictures can help your ophthalmologist to see which type of AMD you have.
- Ocular coherence tomography (OCT). This is a scan that shows your ophthalmologist detailed pictures of your retina.
If you smoke, stopping smoking is an important part of your treatment. This is because smoking increases the risk of your condition becoming more severe. If you need advice about stopping smoking, contact your GP for advice.
Dry age-related macular degeneration
There’s currently no cure or treatment for dry AMD.
Some research has shown that taking certain vitamin supplements may help to slow down the progression of dry AMD. For example, some studies show that a certain combination of vitamins, called the AREDS supplement may be helpful. These supplements contain large doses of vitamins A (beta-carotene), C and E and the mineral zinc. If you smoke, or have smoked in the past, you shouldn't take beta-carotene supplements because these could increase your risk of lung cancer. Beta-carotene may also increase the risk of bladder or kidney problems in smokers.
A recent study found that the antioxidants lutein and zeaxanthin may be safer and possibly work better than beta-carotene. Antioxidants protect our cells and tissues from being damaged by harmful substances. AREDS2 supplements contain lutein and zeaxanthin instead of beta-carotene. More research is needed to be certain of how beneficial these supplements are in slowing down the progression of AMD.
If you carry out close, detailed work, you can use visual aids, such as magnifying glasses, to help you see more clearly. If you enjoy reading, you may be able to read large print books or may prefer to try audiobooks. By making things bigger, brighter and more colourful, you will make things easier to see.
Wet age-related macular degeneration
A number of treatments are available for wet AMD. These work mainly by stopping new blood vessels from growing behind your retina. You’ll need to start treatment as soon as possible. If blood vessels grow for too long, they can scar your retina and cause permanent damage.
Your ophthalmologist can inject medicines called anti-vascular endothelial growth factor (anti-VEGF) into your eye. This is called an intravitreal injection – the medicine is injected into the vitreous, the gel-like substance in your eye. Anti-VEGF medicines work by stopping new blood vessels growing.
You’ll probably need to have more than one injection − usually once a month for the first three months. Your eye will be monitored closely to see if you need further treatment. You may need to have treatment and follow up appointments for a long time, usually at least a year or two. The injection shouldn’t be painful but your eye may be sore after the anaesthetic wears off. Around one in every three people who have anti-VEGF treatment find that their vision gets better. The main complications of anti-VEGF treatment are a rise in pressure in your eye, a detached retina and eye infections.
Photodynamic therapy (PDT)
Photodynamic therapy (PDT) doesn’t restore your vision, but it can help stop wet AMD from getting worse. Your ophthalmologist will inject a special light-sensitive dye into your arm, which then travels to your retina. They will then focus a low-energy, cold laser on the macular area of your retina. This destroys any abnormal blood vessels, without affecting the surrounding healthy tissue. PDT can sometimes cause a temporary loss of vision, back pain or sensitivity to sunlight.
The cause of AMD is still unknown. But there are some things that increase your risk of getting AMD. These include the following.
- Your age. You’re more likely to develop AMD as you get older.
- Smoking. If you smoke, you’re more than three times more likely to develop AMD than a non-smoker.
- Having a family history of AMD, for example, if other members of your family have it.
- Being female – more women than men develop AMD, but this may be because women tend to live longer.
- Not eating enough foods containing vitamins and minerals, such as vitamins A and C and zinc.
You can help reduce your chances of developing AMD by:
- stopping smoking
- eating a healthy diet with plenty of fruit, vegetables and oily fish
- having an eye examination every two years to pick up early signs of the disease
See your optometrist as soon as possible if you notice any changes in your eyesight. Diagnosing AMD early on can help you get the right treatment.
Currently, there’s no cure or treatment for dry AMD. But there are many scientific research studies looking into this.
Scientists are looking for new treatments for AMD all the time. Some scientific researchers are looking into new medicines to treat dry AMD. Others are focusing on gene therapy, specific foods or nutritional supplements. Gene therapy involves replacing missing or defective genes in cells with normal healthy genes. In some people, AMD has been linked to a specific gene that doesn’t work as well as it should.
All of these treatments need further research to see how well they work and how safe they are.
Living with AMD isn’t always easy and you may find it hard at first to cope with the changes to your vision. You could join a support group to meet and learn from other people in your situation. There are also lots of things you can do to help you make the most of the vision you have.
When you’re first diagnosed with AMD, you may feel upset or overwhelmed. Talking to other people in your position can help you to cope. Getting in touch with patient groups can be a valuable source of help and support. Some of these are listed in our further information section below.
It may take you a while to adapt to using your peripheral vision – what you see at the sides rather than in front of you. Visual aids, such as magnifying devices and large computer screens, can help you see things close to you. Telescopes can help you see things further into the distance. You can also buy gadgets to help you with everyday tasks, such as high power reading glasses, dictation software and software that reads to you.
Having AMD can make you more likely to fall over and injure yourself. It may be possible to register as sight impaired (partially sighted) or severely sight impaired (blind). This may give you certain financial benefits and help with day-to-day living.
AMD affects everyone differently – you may find that your vision isn’t severely affected. But having a long-term medical condition, such as AMD, can make you feel a bit down. Talk to your GP or ophthalmologist for more advice about how to cope with daily living.
It’s unusual to lose all of your vision because of AMD. This is because AMD affects your central vision, rather than your side (peripheral) vision.
Both types of AMD affect the central part of your vision. This means that you will still have peripheral vision, or vision at the sides or the edges of your sight. If you have dry AMD, you don’t usually lose all of your sight. But if you have wet AMD, you can lose a lot of your central vision if it isn’t treated quickly.
Having peripheral vision means that you should still be able to get around on your own. But you may need help to make the most of the vision you have. Your optometrist will check that your remaining vision is as good as it can be and will prescribe suitable glasses if you need them. You may be eligible to register as blind or partially sighted.
Your ophthalmologist can refer you to low vision services to help you cope with your sight loss. This will make sure you can continue with most of your usual activities.
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- Age-related macular degeneration. BMJ Best Practice. www.bestpractice.bmj.com, published 3 October 2014
- Eye globe anatomy. Medscape. www.emedicine.medscape.com, published 18 July 2015
- Macular disorders. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 18 February 2014
- Retina anatomy. PatientPlus. www.emedicine.medscape.com, reviewed 18 July 2015
- Age-related macular degeneration. PatientPlus. www.patient.co.uk/patientplus.asp, reviewed 18 October 2013
- Eyes. Oxford handbook of geriatric medicine (online). Oxford Medicine Online. www.oxfordmedicine.com, published July 2012 (online version)
- Age-related macular degeneration. Macular Society. www.macularsociety.org, accessed 21 July 2015
- Understanding AMD. The Royal College of Opthalmologists. www.rcophth.ac.uk, accessed 21 July 2015
- Ophthalmology. Oxford handbook of general practice (online). Oxford Medicine Online. www.oxfordmedicine.com, published April 2014 (online version)
- Age-related macular degeneration (AMD or AMRD). The Merck Manuals. www.merckmanuals.com, reviewed September 2014
- Nursing patients with sensory system problems (eyes, ears, nose, and throat). Oxford handbook of adult nursing (online). Oxford Medicine Online. www.oxfordmedicine.com, published August 2010 (online version)
- Commissioning better eye care: age-related macular degeneration. The Royal College of Ophthalmologists. www.rcophth.ac.uk, published 25 November 2013
- Evans JR, Lawrenson JG. Antioxidant vitamin and mineral supplements for slowing the progression of age-related macular degeneration. Cochrane Database of Systematic Reviews 2012. doi: 10.1002/14651858.CD000254.pub3
- The age-related eye disease study 2 (AREDS2) research group. Lutein and zeaxanthin and omega-3 fatty acids for age-related macular degeneration. JAMA 2013; 309(19):2005−15. doi: 10.1001/jama.2013.4997
- Age-related macular degeneration (AMD). RNIB. www.rnib.org.uk, published September 2013
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- Ranibizumab and pegaptanib for the treatment of age-related macular degeneration. National Institute of Health and Care Excellence (NICE), May 2012. www.nice.org.uk
- Aflibercept solution for injection for treating wet age‑related macular degeneration. National Institute of Health and Care Excellence (NICE), July 2013. www.nice.org.uk
- Joint Formulary Committee. British National Formulary (online) London: BMJ Group and Pharmaceutical Press. www.medicinescomplete.com, accessed 21 July 2015
- Guidance on the use of photodynamic therapy for age-related macular degeneration. National Institute of Health and Care Excellence (NICE), September 2003. www.nice.org.uk
- Askou AL. Development of gene therapy for treatment of age-related macular degeneration. Acta Ophthalmol 2014; 3:1–38. doi:10.1111/aos.12452
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- Hobbs RP, Bernstein PS. Nutrient supplementation for age-related macular degeneration, cataract, and dry eye. J Ophthalmic Vis Res 2014; 9(4):487–93. doi:10.4103/2008-322X.150829
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- Vitamins. British Nutrition Foundation. www.nutrition.org.uk, accessed 28 July 2015
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Reviewed by Hemali Bedi, Bupa Health Content Team, 26th October 2015.
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